Cutaneous Malignant Melanoma in Chile: Differences in Tumor Thickness and Overall Survival Between Patients From Public and Private Health Care Centers.

INTRODUCTION: A low socioeconomic status (SES) is associated with lower survival rates in cutaneous malignant melanoma (CMM). In South America, there are few studies that analyze CMM data according to SES. OBJECTIVES: To determine the differences in microstaging and overall survival in CMM between public and private health care centers. METHODS: Retrospective cohort study. Histopathological reports with a diagnosis of CMM from two public hospitals (PuH) and one private health care center (PrH) in Santiago from 2008 to 2018 were included. Patients' death certificates were obtained to estimate overall survival. RESULTS: 1014 MMC were found. The mean age was 58.6 ± 16.8 years and 59.9% corresponded to female patients. Of these, 33.9% received treatment at PuH and 66.1% at PrH. Patients from PuH had an increased risk of having an invasive CMM and a >1 mm thickness melanoma compared to PrH (odds ratio 2.77 and 6.06, respectively). Patients with invasive CMM from the PuH were 6.29-fold more likely to die than a patient from the PrH. CONCLUSIONS: We observed a great disparity in tumor thickness between the socioeconomic status, reflecting a later detection and lower survival rate in PuH. Our results highlight a gap on which National Public Health should focus.

Adecuación de los catéteres midline y mini-midline en pacientes con COVID-19 / daptation of midline and mini-midline catheters for patients with COVID-19

Objetivo: analizar el tiempo de permanencia y las principales causas de retirada de los catéteres midline (20 cm) y mini-midline (10 cm) en pacientes hospitalizados, y estudiar las diferencias en pacientes con COVID-19. Método: estudio descriptivo, transversal, retrospectivo realizado con datos de las historias clínicas en el Hospital Universitario Vall d´Hebron (Barcelona, España). Se analizaron catéteres insertados por el Equipo de Enfermería de Infusión y Accesos Venosos (EIAV) en pacientes hospitalizados durante 2020. Resultados: se incluyeron 357 catéteres de 305 pacientes (28,9% tenía COVID-19). Estos últimos presentaron mayor proporción de obesidad (21,6% vs. 9,2%; p= 0,003). La mediana de duración de catéteres insertados fue de 11-12 días, sin diferencias por el tipo de catéter ni por tener COVID-19 (p= 0,88). La principal causa de retirada en ambos grupos fue el fin del tratamiento, siendo mayor en pacientes sin COVID-19 (65,7% vs. 53,1%; p= 0,031), seguida del éxitus en pacientes con COVID-19 (22,9% frente a 8,9%; p= 0,001) y oclusión del catéter en el resto (17,3% vs. 8,33%; p= 0,035). Se dieron n= 4 casos de infección del catéter y n= 31 sospechas, sin diferencias según diagnóstico ni tipo de catéter. El motivo de retirada no varió según el acceso venoso de elección. Conclusiones: no existen diferencias en la duración de los catéteres respecto a su longitud, vena de inserción ni diagnóstico de COVID-19. La venopunción ecoguiada, la técnica estéril y la elección del tipo de catéter por parte de un EIAV parecen disminuir las complicaciones asociadas.(AU)

Objective: to analyse the time of permanence and main causes for removal of midline (20 cm) and mini-midline (10 cm) catheters in hospitalized patients, and to study the differences in patients with COVID-19. Method: a descriptive, cross-sectional, retrospective study conducted with data from clinical records in the Hospital Universitario Vall d´Hebron (Barcelona, Spain). The study included catheters inserted by the Infusion and Vascular Access Nursing (IVAN) Team in patients hospitalized during 2020. Results: the study included 357 catheters in 305 patients (28.9% with COVID-19). The latter presented a higher rate of obesity (21.6% vs. 9.2%; p= 0.003). The median duration of catheters inserted was 11-12 days, without any difference by type of catheter or having COVID-19 (p= 0.88). The main cause for removal in both groups was the end of the treatment, and it was higher in patients without COVID-19 (65.7% vs. 53.1%; p= 0.031), followed by exitus in patients with COVID-19 (22.9% vs. 8.9%; p= 0.001), and catheter occlusion in the rest (17.3% vs. 8.33%; p= 0.035). There were n= 4 cases of catheter infection and n= 31 suspected cases, without difference by diagnosis or type of catheter. There was no variation in the cause for removal according to the venous access selected. Conclusions: there are no differences in terms of duration of catheters according to their length, vein of insertion or COVID-19 diagnosis. Ultrasound-guided venipuncture, sterile technique and selection of type of catheter by a member of the IVAN team seem to reduce the complications associated.(AU)

[Chromoblastomycosis. First allochthonous case treated in Chile]. / Cromoblastomicosis. Primer caso alóctono tratado en Chile.

Chromoblastomycosis is a fungal infection of the skin and subcutaneous tissue, of chronic evolution, caused by dematiaceous fungi. The disease occurs worldwide, mainly in tropical and subtropical regions, but in regions like Chile there is only one report of a human case more than 30 years ago. We present the case of a 46-year-old Haitian man, resident in Chile, with verrucous plaques in the right anterior tibial area of one year of evolution. The diagnosis of chromoblastomycosis was confirmed when muriform cells and dematiaceous colonies were observed in the histopathological analysis and the direct microscopy, respectively. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.

Cromoblastomicosis: primer caso alóctono tratado en Chile / Chromoblastomycosis: first allochthonous case treated in Chile

Resumen La cromoblastomicosis es una infección fúngica de la piel y del tejido subcutáneo, de evolución crónica, causada por hongos dematiáceos que se caracterizan por presentar melanina en su pared celular. La enfermedad se presenta en todo el mundo, principalmente en regiones tropicales y subtropicales. En Chile, solo hay un reporte de caso humano hace más de 30 años. Se presenta el caso de un varón de 46 años, haitiano, residente en Chile, con placas verrucosas en la zona tibial anterior de un año de evolución. El diagnóstico de cromoblastomicosis se confirmó al observar células muriformes en la histopatología y colonias dematiáceas en el cultivo micológico; además, en la miscroscopía directa se observaron conidias compatibles con Fonsecaea spp. Luego de seis meses de tratamiento con antimicóticos sistémicos y crioterapia, se logró la remisión completa de las lesiones.

Abstract Chromoblastomycosis is a fungal infection of the skin and subcutaneous tissue, of chronic evolution, caused by dematiaceous fungi. The disease occurs worldwide, mainly in tropical and subtropical regions, but in regions like Chile there is only one report of a human case more than 30 years ago. We present the case of a 46-year-old Haitian man, resident in Chile, with verrucous plaques in the right anterior tibial area of one year of evolution. The diagnosis of chromoblastomycosis was confirmed when muriform cells and dematiaceous colonies were observed in the histopathological analysis and the direct microscopy, respectively. After six months of treatment with systemic antimycotics and cryotherapy, complete remission of the lesions was achieved.

Sweet syndrome associated with secondary nodular syphilis in an immunocompetent patient

Abstract Sweet syndrome is an inflammatory disease characterized by fever, neutrophilia, papules and erythematous plaques, and a skin neutrophilic infiltrate. Syphilis has been reported among the infectious causes of Sweet syndrome. Syphilis can present atypical manifestations; a rare presentation is nodular syphilis, characterized by nodules with granulomas and plasma cells at histopathology. This case report presents a 20-year-old woman patient, with plaques and nodules, and systemic symptoms. The histopathological exam revealed both non-tuberculoid granulomas and a dense infiltration of polymorphonuclear neutrophils in the dermis. These findings, plus laboratory abnormalities, characteristic of both conditions, were conclusive for Sweet syndrome and nodular syphilis association.

Sweet syndrome associated with secondary nodular syphilis in an immunocompetent patient.

Sweet syndrome is an inflammatory disease characterized by fever, neutrophilia, papules and erythematous plaques, and a skin neutrophilic infiltrate. Syphilis has been reported among the infectious causes of Sweet syndrome. Syphilis can present atypical manifestations; a rare presentation is nodular syphilis, characterized by nodules with granulomas and plasma cells at histopathology. This case report presents a 20-year-old woman patient, with plaques and nodules, and systemic symptoms. The histopathological exam revealed both non-tuberculoid granulomas and a dense infiltration of polymorphonuclear neutrophils in the dermis. These findings, plus laboratory abnormalities, characteristic of both conditions, were conclusive for Sweet syndrome and nodular syphilis association.

Siringocistoadenoma papilífero y carcinoma basocelular en nevo sebáceo: reporte de caso / Papilliferous sarcomatocystoma and basal cell carcinoma in nevus sebaceous: case report

El nevo sebáceo o nevo de Jadassohn es un hamartoma cutáneo congénito poco frecuente formado por múltiples estructuras cutáneas. Presenta potencial de transformación a una variedad de neoplasias epidérmicas benignas y malignas, que suelen presentarse de manera individual. Si bien esta descrito en la literatura, es inusual el desarrollo de más de una neoplasia sobre un nevo sebáceo. En esta publicación se presenta el caso de un hombre de 62 años con una lesión de 3 años de evolución, cuyo estudio histopatológico demostró la presencia de un carcinoma basocelular y un siringocistoadenoma papilífero sobre un nevo sebáceo de Jadassohn.

Nevus sebaceous of Jadassohn is an infrequent cutaneous congenital hamartoma, formed by multiple cutaneous structures. It possesses a transformation potential to benign and malignant epidermic neoplasms, that usually present individually. Even though a few cases have been published, the coexistence of two or more tumors is rare. We hereby present the case of a 62 years old male, with a nevus sebaceous of Jadassohn history, that after excisional biopsy showed the presence of a basal cell carcinoma associated to a syringocystoadenoma papilliferum.

Measurements of valve circumferences and ventricular wall of fetal hearts in Chile.

Diagnosis of cardiac pathology, valvular stenosis, cardiac dilation, and/or cardiac hypertrophy is underestimated if measures of weight, wall thickness, and valve circumference are not obtained. Routine study methodology protocols allow us to obtain values of these measurements for a correct diagnosis of these cardiopathies. The aim of the study is to establish reference values for cardiac measurements in fetuses and to compare them with an international curve of reference. One hundred seventy-one autopsies from week 17 through 41 of gestation were performed on fetuses from the Pathology Unit at the Hospital Barros Luco in Santiago de Chile. Cases with malformations were not considered. Anthropometric and cardiac measurements for each gestational week were taken. A tabulation of data with values (in percentiles) of cardiac weight, valve circumference, and ventricular wall thickness was obtained. Values were similar to an international reference. The curves of values obtained allow for identification of normal parameters of heart weight, valve circumference, and ventricular wall thickness, thereby providing easily accessible data for each gestational week. Abnormal values that fall outside of the curve must be attributed to cardiac fetal pathology.

Pre-surgical high resolution ultrasound of facial basal cell carcinoma: correlation with histology.

The aim of this study was to analyze the scope of pre-surgical high resolution ultrasound in basal cell carcinoma (BCC). BCC is the most common human cancer. According to recent large prospective studies incomplete excision of BCC is higher than expected. Pre-operative imaging may aid surgical planning by identifying the extent and location of a neoplasm, which can be interesting at zones with higher risk of recurrences such as the face. These are slow growing tumors but there are some aggressive types described that can involve deeper structures. Twenty-five patients were studied (10 F/15 M, 48-91 years old; mean age 69.5+/-11.5 years) with suspicious facial lesions < or =1.5 cm. Pre-surgical ultrasound with compact linear 15-7 MHz probe was performed. Ultrasound reported the morphology and thickness of the tumors. The results were correlated with the histology. Ultrasound identified 29 suspicious facial lesions that were removed with tumor-free borders at the first surgery and confirmed by histology. The main location was the nose. Two subclinical satellite lesions at the nasal zone were detected under ultrasound which led to a change in the surgery plan. The intraclass correlation coefficient (ICC) value was used to compare tumor thickness measurements between ultrasound and histology. ICC was considered as very good (0.9). Therefore, ultrasound can be useful to plan BCC surgery, it can recognize lesions, layers of involvement and vascularity patterns in a non-invasive way. It can show subclinical satellite lesions, even though the number of subclinical cases is small and require further investigations. It has a good thickness correlation with histology and may be used as a technique to monitor disease changes following non-invasive medical treatments in the future.

[Clinical features of 32 patients with cutaneous small vessel vasculitis]. / Vasculitis cutánea de vasos pequeños. Revisión clínica en 32 casos.

BACKGROUND: The skin is a common target of small vessel vasculitis, with a wide assortment of pathological changes. This condition is usually associated to systemic diseases. AIM: To report the clinical and pathological features of patients with cutaneous small vessel vasculitis. MATERIAL AND METHODS: A retrospective review of 32 patients with a pathological diagnosis of cutaneous vasculitis. RESULTS: Seventy two percent of patients were women. Cutaneous lesions were mainly located in the lower limbs (94%). The most common lesion was palpable purpura (62%). Connective tissue diseases and systemic vasculitis were the most commonly associated systemic diseases. CONCLUSIONS: Palpable purpura is the most common manifestation of cutaneous small vessel vasculitis, that is usually associated to connective tissue diseases or systemic vasculitis.

Embarazo ovárico / Ovarian pregnancy

Se presenta caso clínico infrecuente de embarazo ovárico en paciente portadora de infertilidad secundaria a factor tubario.

[Clinical manifestation in 5 cases of Behcet's disease]. / Manifestaciones clínicas en 5 casos de enfermedad de Behçet.

Behçet disease is characterized by recurrent oral and genital ulcerations as well as ocular involvement. We report five patients (three women) with this condition. All had oral or genital ulcerations, nodules or pustules. Three patients had an uveitis, two had vestibular involvement and one had a meningoencephalitis. One patient died after a massive hemoptysis.